In my chronic illness psychotherapy practice, I have learned over the years that medication management involves many layers of stress for people with chronic illness, from the timing of meds, to side effects (or worry about side effects), to getting medications and supplies shipped in a timely way from mail order pharmacies, to keeping up with refills and prescriptions, and managing the discomfort and inconvenience some medication treatments entail. But one of the biggest sources of medication-management stress is paying for the drugs chronically ill people may need to manage symptoms, regulate their bodies, and stay alive.
Recently, I went to the pharmacy to pick up my monthly supply of medications for an assortment of autoimmune disorders I’ve had since young adulthood. Anticipating (with some anxiety) having to put another few hundred dollars on my credit card, I was stunned when the pharmacist told me there would be no charge. Zero co-pay. Nada. Zip. I had evidently met my maximum out of pocket. It was a stunning feeling. Literally stunning. Of course, it was not as if these meds were actually “free.” I had already paid thousands of dollars over the course of the year for health insurance premiums, co-pays, and out of pocket charges. Nevertheless, it felt like I was finally catching a break, that I deserved care.
As I walked out of the store, clutching my big bag of medicine, I thought about how in most other developed western countries people pay little or nothing for their medications. Accessible, affordable (or free) medicine is their right—something they deserve as a human being, regardless of income or wealth. I thought about the Type 1 diabetics who have been in the press lately because their rationing of exorbitantly priced insulin has lead to hospitalization and death. I considered my patients who enroll in studies with the hope of getting free medication and care as a benefit of participation. And about a friend who has been going through treatment for breast cancer in New York City, and may choose to travel to Europe to purchase a low-cost medication that is currently unavailable in the US except through participation in a clinical research study. I thought of the incredible recent news that a breakthrough, triple-therapy drug for cystic fibrosis has been found to be effective in prolonging the lifespan of CF patients, but will cost hundreds of thousands of dollars a year for each patient and require the expansion of subsidy programs to increase access.
The exorbitant price of so many medications, and the multiple medications required by many people with chronic illness, is a source of constant stress for those who are not wealthy or well off, or who don’t have good prescription coverage. The financial burden of maintaining a chronic illness, even if you have a relatively decent employer or student health insurance plan —all the co-pays and deductibles or treatments services and physicians who may be out of network—can exact a serious toll on patient’s mental health. It is in some ways mind-boggling to me as a psychotherapist to consider that my practice is driven, in part, by the stress and anxiety of patients whose mental health is threatened not only by the demands of living with chronic illness, but by the burden of living within the US health care system itself. For this reason, I believe being a mental health care provider includes being an advocate and an activist for health equity and access–for our patients, for us all. We are in it together.
Please note: all patient anecdotes and experiences that may be described (now or in the future) in this blog are composites, and no individual patient’s story will ever be shared.
For links to advocacy organizations working to increase access to medication, as well as resources for mindfulness-based stress reduction for coping with the challenges of medication-management, and information about my psychotherapy services for people living with chronic illness– check out my website: www.chronicillnesscounselingnyc.com
